Burch colposuspension

About Burch colposuspension

If you have stress incontinence, you can accidentally leak urine after sudden pressure on your bladder, such as when you cough, laugh or lift something heavy. This happens because your pelvic floor muscles and the muscle that closes your urethra (the urethral sphincter – a group of muscles that surrounds your urethra and keeps urine in your bladder) are weak and unable to stop urine from leaking. For more information about the importance of pelvic floor muscles, see our frequently asked questions.

Burch colposuspension aims to give you more control over your bladder by re-positioning the neck of your bladder with supporting stitches and lifting your vagina and bladder neck upwards.

What are the alternatives to Burch colposuspension?

There are a number of alternative treatments for stress incontinence. These include:

  • tension-free vaginal tape (TVT) or transobturator tape (TOT), which your surgeon will fit under your urethra to keep the neck of your bladder closed – this is the most common initial treatment
  • having your pelvic floor muscles electrically stimulated to strengthen them
  • a medicine to stimulate a specific part of your nervous system to prevent leaks
  • injections of substances, such as collagen, into your bladder neck to prevent leaks
  • having an artificial urinary sphincter inserted – this is only an option if other treatments have failed

Your doctor or surgeon will discuss which treatment options may be suitable for you.

Preparing for Burch colposuspension

Your surgeon will explain how to prepare for your Burch colposuspension.

Burch colposuspension usually requires an overnight stay in hospital but you may need to stay for longer depending on the type of operation you have. It’s usually done under general anaesthesia. This means you will be asleep during the procedure.

At the hospital your nurse may check your heart rate and blood pressure, and test your urine. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during Burch colposuspension

Burch colposuspension can be done by open surgery or keyhole surgery.

In open surgery, your surgeon will make a cut in your lower abdomen (tummy).In keyhole (laparoscopic) surgery, your surgeon will make two or three small cuts in your lower abdomen and will insert a tube-like telescopic camera, which will send pictures to a monitor so he or she can see the area to be operated on. Your surgeon will pass specially designed surgical instruments through the other cuts.

If you're having keyhole surgery, there's a chance your surgeon may need to convert the procedure to open surgery. However, keyhole surgery isn't routinely used in the UK and it isn't suitable for everybody – ask your doctor if it’s an option for you.

For both surgical techniques, your surgeon will lift the neck of your bladder by stitching the top (anterior wall) of your vagina to the ligament behind your pubic bone.

The operation usually takes around one hour depending on the technique your surgeon will use.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

If you had open surgery, you may have a catheter to drain urine from your bladder into a bag. It will usually be removed after a day. It’s possible you may need to have the catheter put back in if there are any complications of the surgery. You may also have fine tubes running out from your wound. These drain fluid into another bag and are usually removed after a day or two.

You will be given a sanitary towel to absorb any bleeding from your vagina.

You may be constipated after the operation but it's important not to strain when you go to the toilet as it will put pressure on your healing wound. Let the nursing staff know if you think you may be constipated and they will arrange treatment for you. For more information, see our frequently asked questions.

The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in about seven to 10 days. If you have surgical clips, these will be removed seven to 10 days later.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

Recovering from Burch colposuspension

It usually takes about six to eight weeks to make a full recovery from Burch colposuspension, but this varies between individuals, so it's important to follow your surgeon's advice. It’s best not to have sex until at least six weeks after your operation. Your surgeon will give you advice about when you can resume your usual activities and return to work at your follow-up appointment.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Contact the hospital or your GP if you develop any symptoms that may suggest you have an infection. These include:

  • a burning sensation when you pass urine and/or foul-smelling urine
  • increasing pain or pain that can't be controlled with painkillers
  • a high temperature

What are the risks?

As with every procedure, there are some risks associated with Burch colposuspension. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of Burch colposuspension include:

  • discomfort
  • some vaginal bleeding for a few days

Complications

Complications are when problems occur during or after the operation. Complications of Burch colposuspension include:

  • infection – if you develop an infection you may need to take antibiotics
  • difficulty passing urine or being unable to empty your bladder fully – if this happens you may need a temporary catheter
  • overactive bladder – you may need to pass urine more often and urgently for the first few weeks
  • damage to your urethra or bladder – you may need further surgery to repair this
  • pelvic organ prolapse – there's a slight risk that your womb will slide down into your vagina and if this happens you may need further surgery
  •  pain when you have sex – this can happen as the shape of your vagina may change

What are pelvic floor muscles and how can they help with stress incontinence?

Answer

Pelvic floor muscles span the area between your legs, and support your bladder, uterus and bowel. If you have strong pelvic floor muscles, they give you more control over your bladder and help stop urine leaking accidentally.

Explanation

Pelvic floor muscles form a sling passing from your coccyx (tip of your spine) at the back, to your pubic bone at the front. Your urethra (the tube that carries urine from your bladder out of your body), vagina and anus pass through your pelvic floor. Therefore, strengthening your pelvic floor muscles can help stop accidental leakage when you cough, laugh or make sudden movements. Strong pelvic floor muscles also make it less likely for your womb to slide down into your vagina.

The following is a guide of how to do pelvic floor muscle exercises. Check with your physiotherapist or surgeon before you do these exercises.

  • Get into a comfortable position, either lying on your back or sitting upright in a chair.
  • Imagine trying to stop yourself passing wind and urine. This should feel like a squeeze and lift inside.
  • Squeeze and lift for 10 seconds as strongly as you can. Rest for 10 seconds and repeat 10 times. Follow with 10 fast squeezes.
  • Do this three times every day. Breathe normally as you do the exercises.

What can I do to improve my bowel movements after having Burch colposuspension?

Answer

Eat a diet rich in fibre, fruit and vegetables and have enough to drink. This is often all that is needed to improve your bowel movements.

Explanation

Mild constipation is common after surgery. But it's important to try and avoid this because straining when you go to the toilet is uncomfortable and can put pressure on your healing wound.

To help improve your bowel movement, make sure that your diet is rich in fibre. Fibre is essential for healthy bowel function. When fibre passes through your bowel, it absorbs a lot of water and increases the bulk of any waste matter. It also makes your faeces softer and increases the speed and ease with which it passes through your bowel.

To keep your bowel function regular:

  • eat at least five portions of fruit and vegetables per day
  • base your meals around starchy foods like wholegrain bread, rice and pasta
  • try to include other types of high-fibre foods in your diet like oats, beans, peas, lentils and seeds
  • keep hydrated by drinking enough fluids
  • don’t take medicines that may cause constipation, such as codeine – ask your pharmacist for advice on which medicines can cause constipation

If these measures don’t help, ask your GP for advice.
 

What are my treatment options if the Burch colposuspension fails?

Answer

Burch colposuspension has a fairly good success rate. About 50 to 70 women in 100 are cured or find that their symptoms are significantly improved after having Burch colposuspension.

Explanation

Burch colposuspension is sometimes done using keyhole surgery because this procedure leaves less scarring and has a quicker recovery time. Most women find their symptoms are completely cured or significantly improved after the operation. But, if your symptoms return and the keyhole surgery has failed, your doctor may recommend repeat Burch colposuspension using the open surgery technique. Open surgery involves making a larger cut in your lower abdomen and usually has a longer recovery period.

Your surgeon will be able to give you advice on other treatment options available, which may include:

  • surgery to have tension-free vaginal tape (TVT) or transobturator tape (TOT) fitted under the middle part of your urethra to provide support
  • injections of a collagen-like substance into your bladder neck to prevent leaks – however, you will need to keep having these injections to stop the effects wearing off
  • having an artificial urinary sphincter inserted – this will only be offered to you if your stress incontinence is severe and other treatments have failed

For more information on these treatment options, ask your doctor or surgeon for advice.